FACULTY OF NURSING AND ALLIED HEALTH SCIENCES

_________________________________________________________________________
NMNC5103
HEALTHCARE MANAGEMENT
ASSIGNMENT
SEPTEMBER SEMESTER 2016
_________________________________________________________________________

Task:
Discuss the leadership competencies and the strategies to be taken by the healthcare
managers in ensuring the efficiency and the effectiveness of health care organization
performance.

Name: MAIZATUL AKMAR BT IBRAHIM

Matric number: CGS01304221

NRIC: 720618145398

Telephone number: 0123817871

E-mail address: akmar1972@yahoo.com

Tutors name: Dr. Aini Binti Ahmad

Learning Centre: JOHOR BAHRU

SEPTEMBER SEMESTER 2016

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LEADERSHIP AND LEADERSHIP STYLES

Leadership is the ability to inspire individual and organizational excellence, create a

shared vision and successfully manage change to attain an organizations strategic ends and
successful performance. According to BusinessDictonary.com (2013), leadership is defined in
many different ways and has many dimensions. Strong leadership includes, having a clear
vision and communicating it clearly and passionately to inspire willing participants in the
collaborative process of realizing the vision. It also includes providing information, knowledge
and other essential tools to all who share the vision and follow the path of achieving the vision.
A leader is a visionary coach and guide the expertise in facilitating collaboration and
coordinating personal, intellectual, and financial and other valuable resources while balancing
the interests of multiple level of customers and stakeholders to achieving optimal outcomes.
The scientific study of leadership did not begin until the 20 th century because of strong
management skills were historically valued more than strong leadership skills. Early works
focus on broad conceptualization of leadership, such as the traits or behaviors of the leader.
Contemporary research focuses more on leadership as a process of influencing others within an
organization culture and the interactive relationship of the leader and follower. The early
leadership theories tend to focus upon the characteristics and behaviors of successful leaders,
later theories begin to consider the role of followers and the contextual nature of leadership.
Great Man theories based on the belief that leaders are exceptional people, born with innate
qualities, destined to lead. The use of the term man was intentional since until the latter part of
the 20th century, leadership was thought of as a concept which is primarily male, military and
Western. This led to the next school of trait theories. In the Trait theories, the list of traits or
qualities associated with leadership exist in abundance and continue to be produced. They draw
on virtually all the adjectives in the dictionary which describe some positive or virtuous human
attribute, from ambition to zest for life. The characteristics identified in trait theories, such as
intelligence, knowledge, judgement decisiveness, independence, adaptability, alertness and self-
confidence are still use to describe successful leaders today. The Behavioral theories
concentrate on what leaders actually do rather than on their qualities. Different patterns of
behavior are observed and categorized as styles of leadership. This area has probably
attracted most attention from practicing managers. Situational leadership approach sees

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leadership as specific to the situation in which it is being exercised. For example, whilst some
situations may require an autocratic style, others may need a more participative approach. It
also proposes that there may be differences in required leadership styles at different levels in
the same organization. In the Contingency theory, this is a refinement of the situational
viewpoint and focuses on identifying the situational variables which best predict the most
appropriate or effective leadership style to fit the particular circumstances. Transactional theory
approach emphasizes the importance of the relationship between leader and followers, focusing
on the mutual benefits derived from a form of contract through which the leader delivers such
things as rewards or recognition in return for the commitment or loyalty of the followers. In the
Transformational theory, the central concept here is change and the role of leadership in
envisioning and implementing the transformation of organizational performance. Each of these
theories takes a rather individualistic perspective of the leader, although a school of thought
gaining increasing recognition is that of dispersed leadership. This approach, with its
foundations in sociology, psychology and politics rather than management science, views
leadership as a process that is diffuse throughout an organization rather than lying solely with
the formally designated leader. The emphasis thus shifts from developing leaders to
developing leaderful organizations with a collective responsibility for leadership. There are
many identified styles of leadership, and Servant leadership is one that, has grown in popularity
in the last few years. In the 1970s, Robert Greenleaf created this term to describe leader who
influence and motivate others by building relationships and developing the skills of individual
team members. A servant leader makes sure the needs of the individual team members are
addressed. In this styles of management, the entire team has input into decision making based
on the organizations values and ideals. Servant leaders create devoted followers in response to
positive attention they give. Characteristic skills of a servant leader include: listening;
acceptance; awareness, persuasion; foresight; commitment to the growth of others; and building
community within the organization. A very similar style, Transformational leadership, also
based on building relationships and motivating staff members through a shared vision and
mission. Transformational leaders typically have charisma to communicate vision, confidence
to act in a way that inspire others, staff respect and loyalty from letting the team know they are
important, and this leader are masters at helping people do things they werent sure they could
do by giving encouragement and praise. Another similar style is the Democratic leader who

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encourages open communication and staff participation in decisions. Workers are given
responsibility, accountability, and feedback regarding their performance. Relationships are
important to this leader who places a focus on quality improvement of systems and processes,
rather than on mistakes of individual team members. The Authoritarian or Autocratic leadership
style is demonstrated when a leader makes all decisions without considering input from staff.
Negative reinforcement and punishment are often used to enforce rules, because knowledge is
seen as power, critical information may be withheld from the team. Mistakes are not tolerated
and blame is placed on individuals rather than on faulty processes. The positive side of this
autocratic leadership style is that it works perfectly in emergencies or chaotic situations where
there is little time for discussion. It is useful when enforcing policies and procedures that
protect resident health and safety, but it does not promote trust, communication, or teamwork
when used for day-to-day operations. Authoritarian leaders are often micromanagers.
Conversely, Laissez-faire leadership is a style in which the leader provides little or no direction
or supervision, and prefers to take a hands-off approach. Decisions are not made, changes
rarely occur, and quality improvement is typically reactive, not proactive. It is most often used
by new, inexperienced leader or by those at the end of their career who choose not to address
issues since things will soon be changed by their replacement leader.

NURSING LEADERSHIP

In healthcare administration, leaders are role models for their organization

employees, and they need to be aware that their actions are being watched at all times.
Sometimes people at the top of an organization get caught up in what they are doing and do not
realize the message they are sending throughout the workplace by their inappropriate behavior.
Specific ways of serving in the role of a healthcare leader can be demonstrated and can provide
the exemplary model needed to send the correct message to employees. These appropriate ways
in which a leader acts are called protocols. Professionalism is essential to good leadership. This
can be manifested not only in the way people act but also in their mannerisms and their dress. A
leader who comes to work in sloppy attire or exhibits obnoxious behavior will not gain respect
from followers. Trust and respect are very important for a leader to acquire. Trust and respect

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must be a two way exchange if a leader want to get followers to respond. Employees who do
not trust their leader will consistently question certain aspects of their job. If they do not have
respect for the leader, they will not care about doing a good job. This could lead to low
productivity and bad service. Even a leaders mood can effect workers. A leader who is
confident, optimistic and passionate about her work can instill the same qualities in the
employees. Such enthusiasm is almost always infectious and is passed on to others within the
organization. The same can be said of a leader who is weak, negative and obviously
unenthusiastic about her work, these poor qualities can be acquired by others. Leaders must be
very visible throughout the organization. Having a presence can assure employees that the top
people are at the helm and give a sense of stability and confidence in the business. Leader
when do rounds, can help them to meet certain standard goals: making sure that the staff
know they are cared about, know what is going on (what is working well, who should be
recognized, which systems need to work better, which tools and equipment need attention), and
know that proper follow-up action are taking place (Quint Studer, 2009). Leader must open
communicators. Holding back information that could have been shared with followers will
cause ill feelings and a concern that other important matters are not being disclosed. Leaders
also need to take calculated risks. They should be cautious, but not overly so, or they might lose
an opportunity for the organization. And finally, leaders in todays world need to recognize that
they are not perfect. Sometimes there will be errors in what they said or done. These must be
acknowledged so they can be put aside and the leader can move on to more pressing current
issues. Nursing is a practice discipline and it is a political act. Nursing leadership is about
critical thinking, action and advocacy and it happens in all roles and domains of nursing
practice. Nursing leadership plays a pivotal role in the immediate lives of nurses and it has an
impact on the entire healthcare system. Therefore, the healthcare system requires a steady
supply of visionary and energetic nursing leader across the domains of the discipline who are
credible, courageous, visible and inspiring to others and who have the authority and resources
to support modern, innovative and professional nursing practice. The development of nursing
leaders must begin at the outset of every nursing education program and continue throughout
the career of every nurse. Leadership in this context is about helping nurses lift their practice,
so they can see nursing not solely as a series of acts of scientific caring that can change
individual lives only but also as a lifelong commitment to political action for system change.

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Leadership begins when students are imbued with the meaning of ethical nursing practice and
continues throughout ones career as nurses make the links from individuals to populations, and
from the local to the global context. In nursing leadership, nurses must competent and engaged
practice to provide exemplary care, can think critically and independently, inform their practice
with evidence, delegate and take charge appropriately, advocate for patients and communities,
insist on practicing to their full and legal scope and push the boundaries of practice to innovate
new level. Nurses must create and use research, ask the kinds of questions and seek the kinds of
answers that can shape healthy public policy. Nursing leadership is mentoring junior researcher
and linking closely with practice and policy leaders to help shape larger public policy outcome.
Leadership in this domain was combining science with a deep understanding of population
health need, nursing practice and nursing education to envision new futures and drive the
nursing discipline strongly forward. Leadership will guide nurses to develop, analyze and
interpret policy, speak with knowledge of human health, health and regulator systems and
health economics also usefully and credibly inform the development of regulatory frameworks
and healthy public policy. Nursing leadership is about innovative and visionary administrators
from the first level to the most senior nurse executive, therefore leaders must understand and
hold themselves accountable for creating vibrate, exciting practice settings in which nurses can
deliver safe, accessible, timely and high quality care for the community.

LEADERSHIP COMPETENCIES

A leader needs certain skills, knowledge and abilities to be successful. This values are
called competencies. Hutton & Moulton (2004) stated that, some of the competencies are
technical, for example, the leader who having analytical skills, having a full understanding of
the law, a leader who being able to market and write. Some of the competencies are behavioral,
such as, the leader who was decisiveness, being entrepreneurial and an ability to achieve a good
work or life balance. As people move up in organizations, their behavioral competencies are a
greater determinant of their success as leaders then their technical competencies. Huston (2008)
suggested a set of eight leadership competencies that are likely to be essential for nurse leaders.
The group of competencies is broad but leads a different dimension to comprehensive

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leadership preparation for the next decade. These competencies include: global perspective;
working knowledge of technology such as the electronic health record, clinical decision
support, and critical biometrics; expert decision-making skills, including the use of evidence-
based practice to develop best practices for delivery of care; integrating quality and safety into
organizational culture; wisely interacting with policies and politics in the healthcare system;
collaborating and building inter-professional teams and positive and productive patient care
environments; balancing authentic leadership and performance expectations; and being
proactive in guiding change to facilitate continuous quality improvement using a visionary
approach to systems transformation. These leadership competencies are similar to those
described by selected specialty organizations and academic guidelines for leadership
development. Leadership competencies were include general leadership strategies, data driven
decision making, communication, conflict management, change theory, systems thinking and
complexity science, healthcare systems and organizational relationships, healthcare finance,
healthcare system operations, and principles of teamwork and care coordination of individuals
and populations.
Leadership competencies is needed in every nursing position across all domains of
practice from the enthusiastic student to competent senior staff nurse, from the excellent team
member to the senior manager, and from the novice researcher to the most experienced
educator. According to Ewens (2003), all patients wanted the well trained nurses who could
provide them with the best available nursing care, based on updated evidence and in a
respectful and caring manner. Leaders also considered competent, well educated, motivated and
interested staff as the most important factor to achieve the goals of nursing. To this end
professional development was considered vital by nurse leaders (Furaker, 2003). Patient, team,
organizational and healthcare system outcomes all benefit when nurses in all domain of practice
and at all levels maximize their leadership potential. With the collective energy of share
responsibility and leadership, nurses can form strong networks and relationships that contribute
to high quality nursing practice. To support high quality professional practice and help nurses
feel safe, respected and values, a sense of human caring among all health professionals must
characterize all work environments. Nurse leader have an ethical obligation which, when
resources are not available, she must collaborate with others to adjust priorities and minimize
harm and to inform employers about potential threats to safety in order to provide safe,

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compassionate, competent and ethical nursing care. Nursing leaders and administrators are
charged with creating and maintain those kinds of practice environments for the benefit of all
people who are receiving healthcare services and all people who are providing them. Takase et
al. (2011) stated that nursing competence is defined as the ability of nurse to effectively
demonstrate a set of attribute, such as personal characteristics, values, attitudes, knowledge and
skills, which are required to fulfil her professional responsibility. It is the exhibition of this
competence that enables a nurse to provide safe and effective patient care (Alxley 2008, Valloze
2009). Continuing competence in nursing leadership requires nurses to maintain their current
knowledge, skills and attitudes to offer standard nursing care in a rapidly changing healthcare
environment (Arcand & Neumann 2005, Philipsen et al. 2007). It does not mean that nurses
remain at the level of competence they had at the time of registration. The current concept of
continuing competence, however, involves more than keeping pace with healthcare
advancements. It also demands continuous professional development, through which nurses
acquire a higher level of competence throughout their career pathways (Canadian Nurses
Association 2000).This means that maintaining a certain level of competence that is enough to
offer standard nursing care, is no longer sufficient. Through formal and informal learning,
nurses are required to provide high quality nursing care, acquire new competences in areas they
were not previously familiar with and develop the competence that they have already achieved
at certain levels (Canadian Nurses Association 2000). According to Munro (2008), continuing
the competence of nurses has become a mandatory requirement of healthcare organizations,
professional nursing bodies and the public. Nevertheless, little is known about how the level of
nurses competence changes throughout their career pathway. Apparently, the lack of this
knowledge hinders the development of appropriate interventions to support the continuing
competence of nurses. Nursing leadership challenges such as staffing, competency
development, ageing population, reduced healthcare funding and maintaining quality are now
become common global problems (Parker & Hyratus 2011). Another challenges for nursing
leaders is undesirable patterns that include the widely shortage of nurses in the workforce and
the high rates of turnover among nurses. Healthcare organizations increasingly depend on
recruitment and retention of nurse managers to reverse these trends. Nurses become leaders
through a variety of routes, many of which do not include formal managerial training or
education. To produce positive result, leaders need effective strategies to manage departmental

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operations and inspire staff. One strategy used by chief nursing officers, professional nursing
associations, and employers is to design and implement formalized leadership and managerial
training program that are evidence based and results oriented. The highly divergent and
dynamic leadership skills described herein mirror the responsibilities of managers. The skills
also illustrate the need for open minded leaders who collaborate with colleagues and peers to
prepare for and response to the multifaceted challenges that arise every day. The leadership
skills are grouped into four main categories such as: organizational management;
communication; analysis or strategy; and creation or vision. Administrative teams can use these
skills as the foundation to create competency based job descriptions and development programs
for nurse leaders.

THE SIGNIFICANCE OF LEADERSHIP COMPETENCIES

Changes in healthcare service policies have given nurse leaders the autonomy and
power to improve the quality and effectiveness of patient care. To achieve this, they have to
deploy nurses with the correct mix of professional and personal skills, facilitate collaboration
between professionals and promote diffusion of competence within the staff. The nurse leader
has moved away from management by control and routines and is now a facilitator and
coordinator who empowers nurses to manage their case-loads (Willmot 1998). Aiken et al
(2002) stated that, one major objective for nurse leaders is to ensure the patients and their
relative receive good quality nursing care. Organizational and managerial that support for
nurses has significant impacts on nurse-assessed quality of care. During the 1990s, the nurse
leaders role has been reinforced through the allocation of more tasks and responsibilities such
as; demand for efficiency, development of quality, evidence based practice, work environment
questions and budget responsibility (Berntsson 2003). There has been a movement and
devolution of decision making in the management of nursing (Willmot 1998, Furaker 2003).
Nurse leaders are facilitators and coordinators who empower nurse to manage their work.
Furaker (2003) concluded that a nurse leader needs to make correct decisions, give information
and advice and develop the staffs skills, to provide conditions for qualitative good nursing and
good working environment. There was a significant positive correlation between professional

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development and six variables; autonomy and recognition, role clarity, job satisfaction, quality
of supervision, peer support and opportunities for learning. The identified variables provide a
focus for nurse leaders to support professional development in clinical settings. Caine and
Kendricks (1997) was studied about nurse leaders, also described their role as facilitators in
helping nurses to overcome obstacles, such as lack of time and research knowledge, while
simultaneously ensuring organizational objectives. However, nurse leaders in reality behaved
in a manner which inhibited development of evidence based nursing practice in the ward. Nurse
leader who provided innovative work environments helped nurses developed and integrate their
new roles. According to Reay et al. (2003), others challenges for nurse leader are when new
professional roles were introduced into ward setting, was to clarify the relocation of tasks and
to manage altered working relationships within the nursing team.
Contemporary nursing and healthcare leaders identify the skills which will be
needed by nurse leader to create the educational models and management development
programs necessary to ensure these competencies are present. Nurse leader competencies is
needed in a global perspective or mindset about healthcare and professional nursing issues. The
benefit of a global mindset to the nurse leader is that allows her to proactively identify and
respond to emerging global healthcare and nursing trends which potentially impact national,
regional or even local healthcare planning. A second competency required by nurse leaders is
the ability to integrate technology which facilitates mobility and portability of relationships,
interactions an operational processes. Electronic health records, clinical decision support and
biometrics, are examples of such technology, as all will continue to impact not only what
healthcare data are collected, but how they are used, communicated and stored. Clinical
decision support defined broadly as a clinical system, application or process that helps health
professionals make clinical decisions to enhance patient care (Healthcare Information and
Management System Society 2008, para 1). A third competency essential for nurse leaders is
expert decision making, rooted in empirical science. Decision making is often thought to be
synonymous with management and is one of the criteria on which management expertise is
judged. Indeed, the quality of the decisions leader-managers make is the factor that often
weighs most heavily in their success or failure (Marquis and Husron 2009, p.1).Using
systematic, scientific approaches to problem solving does increase the likelihood of making
quality decisions, although the role of intuition as an adjunct to quality decision making should

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not be overlooked. In addition, decision making based on empirical science and research based,
best practices also increases the likelihood that decisions made will achieve the desire
outcomes. One strategy nurse leaders of the future may increasingly use to address wicked
problems and improve the quality of their decision making is the use of commercially
purchased expert networks such as, communities of top thinkers, managers and scientist, to
help them make decisions (Saint-Ahmad 2008). Such network panels are typically made up of
researchers, healthcare professionals, attorneys and industry executives. Camillus (2008) also
recommends involving stakeholders in brainstorming sessions when wicked problems emerge,
so that an appropriate strategy can be developed and to better align decision making throughout
the organization. A fourth leadership competency for nurse leaders is creating organizational
cultures that recognize quality healthcare, patient and worker safety as paramount. Expert
suggest that current quality problems are exacerbated by organizational cultures which focus on
blame instead of identifying how and why such errors are made, and then addressing the
processes which increase the likelihood of errors occurring. Stumpf (2007, p61) agrees, arguing
that safety aspects of care should be discussed at every opportunity; on rounds, at department
meeting, in discussions with administrators, and in teaching residents and medical students. In
addition, Stumpf suggests that creating or supporting protocols and guidelines and improving
communication among all members of the healthcare will reduce the chance of errors
occurring. White (2006) suggests that organization leaders will be those that lead in identifying
and adopting innovative safety and quality improvement approaches. A fifth competency
essential to nurse leaders is highly developed collaborative and team building skills. Scott
(2006) contends that a paradigm shift took place early in 21 st century, with a transition from
industrial age leadership to relationship age leadership. Industrial age leadership focused on
traditional hierarchy management structures, skill acquisition, competition and control.
Relationship age leadership focuses primarily on the relationship between the leader and her
followers, on discerning common purpose and working together cooperatively. The sixth
competency essential for nurse leaders is ability to balance authenticity with performance
expectation. Authentic leaders are those who are true to themselves and their values and act
accordingly. Stanley (2006, p132) calls this phenomenon congruent leadership, and defines it
as a match (congruence) between the activities, actions and deeds of the leader and the leaders
values, principles and belief. Authentic leadership was described as the glue needed to hold

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together a healthy work environment in healthcare. George (2007) concur, suggesting that 21 st
century organizations cannot developed sustained growth without authenticity in leadership.
The final leadership competency for nurses is being visionary and proactive in response to a
healthcare system, increasingly characterized by rapid change and chaos. Marquis and Huston
(2009) suggest that most 21st century, healthcare organizations find themselves undergoing
continual change directed at organizational restructuring, quality improvement and employee
retention. Contemporary nurse leaders then must be visionary in identifying where change is
needed in the organization and the must be flexible in adapting to change they have directly
initiated or by which they have been indirectly affected (Marquis & Huston 2009).

STRATEGIES BY HEALTHCARE MANAGER FOR ORGANIZATION

PERFORMANCE

Globally, healthcare organizations and their leaders and managers are facing large
challenges such as financial, political, societal and professional to deliver high quality care and
services for less cost. Governance, performance and risk management systems and processes
are all under enormous independent external scrutiny and review. Government, regulators,
commissioners, and professional bodies want to ensure healthcare organizations provide
efficient and effective safe, quality care and services for their communities, population and
healthcare workers. The presence or absence of effective leaders in healthcare can have a stark
consequence on the quality and outcome of care. The delivery of safe, quality and
compassionate healthcare and services is dependent on having effective leaders at the frontline.
Clinical governance have strategies and supports leaders to become affective and effective in
providing and facilitating safe, quality care by drawing together the key concepts associated
with patient safety, risk management, information and communication, accountability and
evidence based practice by: the systematic harmonization of clinical and managerial
responsibilities with accountable practice; team working and interdependency through
integrated working with and between health and social care in both the public and independent
or private sectors; monitoring, changing, evaluating and improving practice to safeguard
standards; the drive for constant quality improvement in all that they do; nurturing a healthcare

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organizational culture and working environment of continuous learning and sharing; placing a
duty of care to improve individual, team and organizational performance and outcome; and
adopting a person-centeredness approach in all that they do. The challenge face leaders in the
ever-changing world of healthcare is recognizing and responding when improvements and
change are required, along with adopting a facilitative people-centered approach to engage,
encourage, enable, empower and enlighten team members and patient or carers to become
partners in the change and evaluative processes. Strategies leaders must have other
competencies such as build multiple external collaborative relationships to support unit
performance, identified and accommodates external political activities to support unit
performance. Develops the vision for the unit and translate this vision into action. Involves the
unit in the creation of the vision and plan. Communicates corporate goals and objectives.
Develops and uses different method to help employees to positively react to change and
actively embraces change efforts and initiatives to improve unit performance. Solving problems
creatively through critical reflection, problem analysis, risk assessment and rewarding
innovation. Promoting empowerment using processes such as delegation and information
sharing to enhance subordinate ownership and empowerment over their task and performance.
Building executive presence in influencing others and having and observable impact at the
executive level, through personal credibility, leadership, confidence and an understanding of
other peoples perspectives and interests.

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CONCLUSION

In the global challenges facing clinical leaders, managers, educators and researchers to
provide safe, quality, compassionate care and services within financial constraints and targets. It
is imperative that nurses do not disinvest in facilitating, resourcing and supporting the
development of aspiring and existing affective and effective clinical leaders in the ward,
department and healthcare organizations in the future. Safe, quality care and services require
clinical leaders who challenge and be challenged to safeguard and protect their patients and
staff. They need to be able to lead from the front, back and the sides. Furthermore, clinical
leaders require support, resources, education and training, reward and recognition and external
peer review by their healthcare organization to be both affective and effective. Healthcare
organizational boards, managers and leaders, and staff need to familiarize themselves with what
and why clinical leaders are important to quality, safety and compassionate care. Essentially, it
is about embracing the fact that all clinical leaders and custodians for safety, quality and care
for those entrusted to their care. Training for the leaders is an effective way to proactively
address operational inefficiencies and ineffective practice in human resource. Leaders should be
encouraged to identify their own weakness and use these skills and tools to develop and
promote competency.

4853 words

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